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[Sonography of the head and neck area - Part 1: Endosonography]. Laryngorhinootologie 2021; 100:483-498. [PMID: 34062579 DOI: 10.1055/a-1353-7859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sonography of the head and neck area plays a major role in both outpatient and inpatient ear, nose and throat medicine. Transcervical ultrasound is an important imaging method, especially in lymph node and tumor diagnostics. Its advantage is the ubiquitous availability and the excellent combinability with endoscopy and palpation. Despite decades of experience with sonography in the head and neck area, in contrast to the transcutaneous application, the transoral or endosonographic approach has so far not been widely used. Here it is often not due to the technical capabilities of the examiner, but rather to the unusual approach within the scope of the investigation. In this context, endosonography may be used primarily in tumor diagnostics in order to establish a complete sonographic examination from in- and outside.
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Contrera KJ, Hair BB, Prendes B, Reddy CA, Zimmer DI, Burkey BB, Tassone P. Clinical Versus Pathologic Laryngeal Cancer Staging and the Impact of Stage Change on Outcomes. Laryngoscope 2020; 131:559-565. [PMID: 32692866 DOI: 10.1002/lary.28924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/02/2020] [Accepted: 06/18/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS Evaluate the impact and accuracy of clinical laryngeal cancer staging. STUDY DESIGN Retrospective cohort study. METHODS Two hundred sixty-five consecutive patients with laryngeal squamous cell carcinoma who underwent total laryngectomy from 2001 to 2017 were studied. Clinical versus pathologic tumor (T) and nodal (N) categories were compared. Logistic regression and Cox proportional hazards analyzed the association of stage change with perioperative factors and outcomes. RESULTS Forty-seven patients (17.7%, accuracy = 0.969 ± 0.010 [standard error]) changed between T1-2 and T3-4. Sixty-four patients (24.1%, accuracy = 0.866 ± 0.020) had inaccurate N category. Salvage patients were less likely to have stage change (downstage: odds ratio [OR] = 0.20, 95% confidence interval [CI]: 0.08-0.50, P < .001; upstage: OR = 0.41, 95% CI: 0.23-0.74, P = .003), but more likely to have inaccurate nodal category (39.8% vs. 11.7%, P < .001). Patients with stage change tended to have greater odds of positive/close margins (upstage: OR = 1.78, 95% CI: 0.91-3.5, P = .092) and chemotherapy (downstage: OR = 2.21, 95% CI: 0.80-6.14, P = .128; upstage: OR = 1.87, 95% CI: 0.85-4.11, P = .119). Stage change was associated with recurrence (P = .047) with downstaged patients less likely to recur (hazard ratio = 0.26, 95% CI: 0.08-0.82, P = .021). Stage change was not associated with positron emission tomography scan, subsite, time to surgery, or mortality. CONCLUSIONS A third of laryngeal cancer patients were downstaged or upstaged after laryngectomy with 18% and 24% of clinical T and N categories inaccurate, respectively. Stage change was less common for salvage patients and associated with risk of recurrence. LEVEL OF EVIDENCE 3 Laryngoscope, 131:559-565, 2021.
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Affiliation(s)
- Kevin J Contrera
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Bryan B Hair
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, U.S.A
| | - Brandon Prendes
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.,Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Chandana A Reddy
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - David I Zimmer
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Brian B Burkey
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.,Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Patrick Tassone
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri, Columbia, Missouri, U.S.A
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Sharma M, Pathak A, Shoukat A, Rameshbabu CS, Goyal S, Bansal R, Hamza R, Charaya K. EUS of the neck: A comprehensive anatomical reference for the staging of head and neck cancer (with videos). Endosc Ultrasound 2019; 8:227-234. [PMID: 31249169 PMCID: PMC6714487 DOI: 10.4103/2303-9027.260860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The use of EUS has application in the nodal staging of head and neck cancer. The technique and the anatomy of head and neck region using EUS have not been described. EUS from three stations in thoracic esophagus, cervical esophagus, and hypopharynx can allow imaging of head and neck. In this article we describe the normal structures from the three stations. The EUS imaging of head and neck can give relevant and additional information in malignancies of head and neck.
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Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Muzaffarnagar, India
| | - Amit Pathak
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Muzaffarnagar, India
| | - Abid Shoukat
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Muzaffarnagar, India
| | | | - Sumit Goyal
- Department of Oncology, Jaypee Hospitals, Noida, Uttar Pradesh, India
| | | | - Rooby Hamza
- Department of Gastroenterology, MES Medical College, Malappuram, Kerala, India
| | - Kshitij Charaya
- Department of Gastroenterology, Consultant Otolaryngologist, Excel ENT, Meerut, India
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van Egmond SL, Stegeman I, Pameijer FA, Bluemink JJ, Terhaard CH, Janssen LM. Systematic review of the diagnostic value of magnetic resonance imaging for early glottic carcinoma. Laryngoscope Investig Otolaryngol 2018; 3:49-55. [PMID: 29492468 PMCID: PMC5824105 DOI: 10.1002/lio2.138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/03/2018] [Indexed: 11/25/2022] Open
Abstract
Objective In early glottic cancer, accurate assessment of tumor extension, including depth infiltration, is of great importance for both staging, therapeutic approach and systematic comparison of data. Our goal was to assess the diagnostic value of MRI in pre‐therapeutic staging of primary early stage (T1 and T2) glottic carcinoma. Study design Systematic review of literature. Methods We conducted a systematic search in Pubmed, Embase, and Scopus up to September 23, 2016. Included studies were selected and critically appraised for relevance and validity. Results Seven out of 938 unique articles were selected, including 64 cases. MRI over‐staged 6% and under‐staged 13% of cT1 and cT2 tumors. However, available data is heterogeneous, very limited and mainly based on subanalysis of a small amount of patients. Reported MRI protocols appear to be suboptimal for small laryngeal lesions. Diagnostic value of MRI for subtle depth infiltration or laryngeal anatomical subsites (eg, laryngeal ventricle, vocal cord, etc.) could not be assessed. Conclusions More studies are needed to assess the diagnostic value of MRI for small glottic tumors.
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Affiliation(s)
- Sylvia L van Egmond
- Department of Otorhinolaryngology and Head & Neck Surgery UMC Cancer Center University Medical Center Utrecht Utrecht The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology and Head & Neck Surgery UMC Cancer Center University Medical Center Utrecht Utrecht The Netherlands.,Rudolf Magnus Institute of Neuroscience UMC Cancer Center University Medical Center Utrecht Utrecht The Netherlands
| | - Frank A Pameijer
- Department of Radiology UMC Cancer Center University Medical Center Utrecht Utrecht The Netherlands
| | - Johanna J Bluemink
- Department of Radiotherapy UMC Cancer Center University Medical Center Utrecht Utrecht The Netherlands
| | - Chris H Terhaard
- Department of Radiotherapy UMC Cancer Center University Medical Center Utrecht Utrecht The Netherlands
| | - Luuk M Janssen
- Department of Head and Neck Surgical Oncology UMC Cancer Center University Medical Center Utrecht Utrecht The Netherlands
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5
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Heyes R, Lott DG. Laryngeal Cysts in Adults: Simplifying Classification and Management. Otolaryngol Head Neck Surg 2017; 157:928-939. [DOI: 10.1177/0194599817715613] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Laryngeal cysts may occur at any mucosa-lined location within the larynx and account for 5% to 10% of nonmalignant laryngeal lesions. A number of proposed classifications for laryngeal cysts exist; however, no previously published classification aims to guide management. This review analyzes contemporary laryngeal cyst management and proposes a framework for the terminology and management of cystic lesions in the larynx. Data Sources PubMed/Medline. Review Methods A primary literature search of the entire Medline database was performed for all titles of publications pertaining to laryngeal cysts and reviewed for relevance. Full manuscripts were reviewed per the relevance of their titles and abstracts, and selection into this review was according to their clinical and scientific relevance. Conclusion Laryngeal cysts have been associated with rapid-onset epiglottitis, dyspnea, stridor, and death; therefore, they should not be considered of little significance. Symptoms are varied and nonspecific. Laryngoscopy is the primary initial diagnostic tool. Cross-sectional imaging may be required, and future use of endolaryngeal ultrasound and optical coherence tomography may revolutionize practice. Where possible, cysts should be completely excised, and there is growing evidence that a transoral approach is superior to transcervical excision for nearly all cysts. Histology provides definitive diagnosis, and oncocytic cysts require close follow-up. Implications for Practice A new classification system is proposed that increases clarity in terminology, with the aim of better preparing surgeons and authors for future advances in the understanding and management of laryngeal cysts.
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Affiliation(s)
- Richard Heyes
- Department of Otorhinolaryngology–Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - David G. Lott
- Department of Otorhinolaryngology–Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Abstract
PURPOSE OF REVIEW Endoscopic ultrasound (EUS) of the larynx is a vertical endoscopic imaging technique that gives further information about the extension of a lesion apart from normal white light endoscopy, chromoendoscopy, as well as palpation. It combines the advantages of ultrasound and endoscopy. Miniprobes or ultrasound endoscopes with 10-20 MHz are applied. The present review is focused on the use of EUS in the larynx especially in the management of laryngeal cancer. RECENT FINDINGS At present, the larynx is routinely assessed by computed tomography and MRI. Alternatively, endoscopic endoluminal application of miniprobes enables the laryngologist to predict the exact extension of a laryngeal tumor larger than 3 mm during microlaryngoscopy before surgery is performed. Generally, tumors are hypoechoic and can easily be differentiated from the surrounding tissue especially in the hyperechoic supraglottic structures. Thyroid cartilage infiltration can be detected by the interruption of the hyperechoic inner perichondrium. SUMMARY EUS proved to be a reliable imaging tool for the investigation of laryngeal lesions and can easily be used during microlaryngoscopy. It offers a higher image resolution compared with computed tomography and MRI and allows a complete sonographic evaluation of the larynx as well as its pathological changes, especially laryngeal cancer. VIDEO FILE LINK: http://links.lww.com/COOH/A19.
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Mannelli G, Cecconi L, Gallo O. Laryngeal preneoplastic lesions and cancer: challenging diagnosis. Qualitative literature review and meta-analysis. Crit Rev Oncol Hematol 2016; 106:64-90. [DOI: 10.1016/j.critrevonc.2016.07.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 06/04/2016] [Accepted: 07/11/2016] [Indexed: 11/27/2022] Open
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Sharma M, Pathak A, Shoukat A, Somani P. Imaging of spaces of neck and mediastinum by endoscopic ultrasound. Lung India 2016; 33:292-305. [PMID: 27185994 PMCID: PMC4857566 DOI: 10.4103/0970-2113.180866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Endoscopic ultrasound (EUS) of the mediastinum was pioneered by gastroenterologists, and it was taken up by pulmonologists when the smaller-diameter endobronchial ultrasound (EBUS) scope was designed after a few years. The pulmonologists’ approach remained largely confined to entry from the trachea, but they soon realized that the esophagus was an alternative route of entry by the EBUS scope. The new generations of interventionists are facing the challenge of learning two techniques (EUS and EBUS) from two routes (esophagus and trachea). The International Association for the Study of Lung Cancer (IASLC) proposed a classification of mediastinal lymph nodes at different stations that lie within the boundaries of specific spaces. These interventionists need clear definitions of landmarks and clear techniques to identify the spaces. There are enough descriptions of spaces of the neck and the mediastinum in the literature, yet the topic mentioned above has never been discussed separately. The anatomical structures, landmarks, and boundaries of spaces will be important to interventionists in the near future during performances of endosonography. This article combines the baseline anatomy of the spaces with the actual imaging during EUS.
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Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Amit Pathak
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Abid Shoukat
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Piyush Somani
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
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Oak C, Ahn YC, Nam SJ, Jung MH, Hwang SS, Chae YG, Lee HS, Lee KD, Jung MJ, Chun BK, Lee HY, Park EK, Kim SW. Multimodal imaging using optical coherence tomography and endolaryngeal ultrasonography in a new rabbit VX2 laryngeal cancer model. Lasers Surg Med 2015; 47:704-10. [PMID: 26349900 DOI: 10.1002/lsm.22409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE Optical coherence tomography (OCT) provides ultrahigh-resolution imaging of tissues within a depth of a few millimeters, whereas ultrasonography provides good imaging further below the surface. We aimed to develop a minimally invasive rabbit model of VX2 laryngeal cancer, suitable for these two imaging modalities through a transoral approach. We also sought to study the utility of combined OCT and endolaryngeal ultrasonography (EUS) for evaluation of early and advanced laryngeal cancer, using this model. MATERIALS AND METHODS VX2 tumor suspension was inoculated into the vocal folds of ten rabbits by injection through the trans-thyrohyoid membrane. The tumor model was characterized by rigid laryngoscopy and the tumor generation rate was 80% (8/10). Correlation between frequency-domain OCT and high-frequency EUS were used to visualize laryngeal tumors in the area of protruding mass formation in four rabbits, one week after injection (group A) and the remaining four rabbits two weeks after injection (group B). RESULTS A small submucosal tumor was observed with rigid laryngoscopy in group A, and pathologic evaluation showed that the tumor was close to the basement membrane of the vocal fold mucosa, but had not invaded. OCT confirmed that the lining of the mucosa and basement membrane of the vocal fold was not broken, but the mucosa had thinned at the most elevated ridge. However, these lesions were not detected by EUS, and the overall shape of the tumor could not be clearly identified by EUS. A large tumor filling the laryngeal lumen was observed with rigid laryngoscopy in group B, and nearly the entire vocal fold, including the paraglottic space, was found to be involved on pathologic analysis. Distinguishing between normal structures and tumor was difficult using OCT; however, EUS confirmed the overall shape, size, and extent of the tumor, and the paraglottic space and thyroid cartilage were shown to be intact. CONCLUSIONS This study is the first experimental trial, assessing the value of multimodal imaging using OCT and EUS in a rabbit VX2 laryngeal tumor model. Combining OCT and EUS helped to identify changes in laryngeal mucous membranes, and could potentially be used to identify laryngeal tumors and predict how tumors progress. This combined modality could help in determining tumor extent, assisting in diagnosis, and establishing a treatment plan for laryngeal cancer.
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Affiliation(s)
- Chulho Oak
- Innovative Biomedical Technology Research Center, Busan, 602-030, South Korea.,Department of Internal Medicine, Kosin University College of Medicine, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
| | - Yeh-Chan Ahn
- Innovative Biomedical Technology Research Center, Busan, 602-030, South Korea.,Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology, Pukyong National University, 45 Yongso-ro, Nam-gu, Busan, 608-737, South Korea
| | - Sung-Jin Nam
- Innovative Biomedical Technology Research Center, Busan, 602-030, South Korea.,Department of Internal Medicine, Kosin University College of Medicine, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
| | - Maan Hong Jung
- Innovative Biomedical Technology Research Center, Busan, 602-030, South Korea.,Department of Internal Medicine, Kosin University College of Medicine, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
| | - Sang Seok Hwang
- Innovative Biomedical Technology Research Center, Busan, 602-030, South Korea.,Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology, Pukyong National University, 45 Yongso-ro, Nam-gu, Busan, 608-737, South Korea
| | - Yu-Gyeong Chae
- Innovative Biomedical Technology Research Center, Busan, 602-030, South Korea.,Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology, Pukyong National University, 45 Yongso-ro, Nam-gu, Busan, 608-737, South Korea
| | - Hyoung Shin Lee
- Innovative Biomedical Technology Research Center, Busan, 602-030, South Korea.,Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
| | - Kang Dae Lee
- Innovative Biomedical Technology Research Center, Busan, 602-030, South Korea.,Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
| | - Min Jung Jung
- Innovative Biomedical Technology Research Center, Busan, 602-030, South Korea.,Department of Pathology, Kosin University College of Medicine, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
| | - Bong Kwon Chun
- Innovative Biomedical Technology Research Center, Busan, 602-030, South Korea.,Department of Pathology, Kosin University College of Medicine, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
| | - Hae Young Lee
- Innovative Biomedical Technology Research Center, Busan, 602-030, South Korea.,Department of Thoracic and Cardiovascular Surgery, Kosin University College of Medicine, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
| | - Eun-Kee Park
- Innovative Biomedical Technology Research Center, Busan, 602-030, South Korea.,Department of Medical Humanities and Social Medicine, Kosin University College of Medicine, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
| | - Sung Won Kim
- Innovative Biomedical Technology Research Center, Busan, 602-030, South Korea.,Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
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Tibbetts KM, Tan M. Role of Advanced Laryngeal Imaging in Glottic Cancer. Otolaryngol Clin North Am 2015; 48:565-84. [DOI: 10.1016/j.otc.2015.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Arens C. Transoral treatment strategies for head and neck tumors. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc05. [PMID: 23320057 PMCID: PMC3544208 DOI: 10.3205/cto000087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The introduction of transoral endoscopic surgery has initiated a fundamental change in the treatment of head and neck cancer. The endoscopic approach minimizes the intraoperative trauma. Due to the lower burden for the patient and the savings potential these methods have gained wide acceptance. These transoral accesses routes allow experienced surgeons to reduce the morbidity of surgical resection with no deterioration of oncologic results. This suggests a further extension of the indication spectrum and a high growth potential for these techniques and equipment in the coming years. For selected patients with selected tumors the minimally invasive transoral surgery offers improved oncological and functional results. In the present paper, different surgical access routes are presented and their indications discussed.
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Affiliation(s)
- Christoph Arens
- Clinic for Ear, Nose and Throat Medicine, University Hospital Magdeburg, Germany
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Arens C, Vorwerk U, Just T, Betz CS, Kraft M. [Advances in endoscopic diagnosis of dysplasia and carcinoma of the larynx]. HNO 2012; 60:44-52. [PMID: 22282010 DOI: 10.1007/s00106-011-2428-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
To improve the preoperative and intraoperative diagnosis of laryngeal cancer and its precursors, various endoscopic imaging techniques have been developed in recent years. These techniques differ markedly in their specific applications and goals. Precisely distinguishing among normal mucosa, dysplasia and invasive carcinoma with these procedures is necessary. Furthermore, the exact identification of tumor margins should be possible. The long-term goal is the development of optical biopsy. Since so far there have only been small studies regarding the evaluation of the presented methods, it is necessary to establish multi-center trials with large sample sizes to accurately estimate the value of these endoscopic imaging techniques.
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Affiliation(s)
- C Arens
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Magdeburg A.ö.R, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
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